New grad in underserved, urban ER?

Anna Flaxis, BSN, RN · Apr 5, 2015

An hour is a long way to travel, especially if you're working 12 hour shifts, but it is doable if it is worth it to you.

Med/Surg experience is a great foundation for other areas of nursing, but really I feel that the practice of staffing Med/Surg units with nurses who are only using it as a stepping stone to get elsewhere does a huge disservice to the patients and to the other staff who have committed to Med/Surg as their area of practice on a long term basis.

I do have mixed feelings about new grads in the ER. Some new grads start out in the ER and do just fine, while others would really benefit from experience in a less fast-paced, less acute, more predictable environment where they can focus on developing their assessment and time management skills- and yes, being in over your head is a realistic concern. I am typically not in favor of new grads in the ER, but it's not hard and fast- there are some people that have the right stuff to become great ER nurses if given the chance.

The main things I would consider as a new grad would be what kind of new grad orientation programs do they offer at each of your different options? How much orientation will you get before you are expected to function fully? Do they offer any classes as part of your orientation? Will you be assigned a willing preceptor who volunteered for the preceptor role, or a staff member who was chosen to be a preceptor without their buy-in?

I was thrown to the wolves as a new grad, but in a sink or swim situation, I am capable of swimming. I don't think that's true for everyone, and I think a lot of times, it's a set-up for failure, so what I would encourage you to think about isn't necessarily what area of nursing to go into right now, but more along the lines of what kind of support you'll get as a new grad.

Bobjohnny · Apr 5, 2015

The main things I would consider as a new grad would be what kind of new grad orientation programs do they offer at each of your different options? How much orientation will you get before you are expected to function fully? Do they offer any classes as part of your orientation? Will you be assigned a willing preceptor who volunteered for the preceptor role, or a staff member who was chosen to be a preceptor without their buy-in?

The is absolutely on point, find out their orientation program. My employer only gives people 6 weeks for orientation(even though policy allows for up to 12!), even if a new grad. It is not nearly enough time to teach them everything that they need to know. I also agree that people who are a preceptor by choice rather than somebody told to be a preceptor generally do better at teaching because they are invested in it.

But, if you are really in need of a job sooner rather than later, you can always move somewhere else later.

zmansc, ASN, RN · Apr 5, 2015

To me the issues at hand are:

1) Can you as a new grad assimilate directly to the ED, or do you need to work in Med/Surg first?

2) The commute, adding 1hr each way to a 12 hr shift, makes it a 14hr day, very tough especially with taking care of the kiddos. How will that work in your family life?

3) The neighborhood of the facility, will you be safe?

As others have mentioned above, the quality of the training program for new grads in the ED your considering will be a huge factor in determining the answer to question 1. I went directly to an ED RN position, but I had a very good supportive team and good program for training me up. My ED Director understood that they needed to put me on a team with seasoned RNs when I moved from an orientee to taking my own load. I had a mother hen who watched over me very closely, sometimes too closely for my liking, but I quickly learned she was doing what she thought was best for me and my patients and she quickly learned she could trust my judgement.

Not all new grads are cut out for the ED first, even with a good program, so a good solid self assessment of yourself is vital to determining this as well. I'm assuming you have done this and that you feel you would be able to be successful in this situation.

As for question 2, only you know the answer to this question. Also, any potential Med/Surg job would presumably have a commute of some time, so the real difference isn't 2 hr, but something less than that. Is relocating an option to reduce the commute? I'm not suggesting moving to the south side, but maybe a place that has a 30min commute? If you own the home, I doubt I would consider that, but if you rent it might be something to consider...

As for question 3, I don't know enough about the safety of the area the hospital is located in, and what you would be exposing yourself to. I have to presume the hospital is safe within the facility, but that would be something you would have to assess yourself. If you know individuals working in the facility they may be able to tell you what issues they have regarding safety and the location.

Good Luck with whatever you decide.

melc0305 · Apr 6, 2015

Thank you for the input! Major life decisions freak me out... I'm going to find out more info about the ER orientation.

Ruby Vee, BSN · Apr 13, 2015

I know that no one can make employment decisions for me but I value everyone's advice here. I am graduating next month and was offered a position in the south side of Chicago at a small hospital. This is not a good area and honestly not the most prestigious hospital, although it is not poorly run. It is also an hour commute for me from the suburbs into the city.
That being said, I would love to get started in the ER and not in Med/Surg where all the suburban opportunities are that I've found. I am also going through a divorce and it is imperative for me to get a job asap to support my kids. I'm not sure how long it will take me to get another offer (I take my nclex in June).
My thought is to get at least a year under my belt as an ER nurse there. Then if it is not a good fit for me, I could try finding something closer to home. But I also feel that environment may have me in over my head. Advice?

A job offer in the hand is worth two in the bush . . .

That said, here are my thoughts:

A well-run hospital is nothing to sneeze at, whether or not it is prestigious. Some of the most prestigious hospitals are poorly run. As far as your resume, what matters most at this point is having a job and keeping that job for a minimum of a year. So since you already have the offer here, you want to do ER and the hospital is well run, that's a vote in its favor.

A bad neighborhood is worrisome, but if you have a dependable car, driving through the bad neighborhood at the same time everyone else is coming and going to that hospital isn't necessarily more dangerous than driving to ye olde suburban hospital on the freeway. I've worked 11 years in a hospital in the middle of what could charitably be called a ghetto, and have rarely had problems. Those problems I have had are mitigated by having a dependable car and driving away from the problem while calling for help if necessary. Hospitals in bad neighborhoods generally take precautions to keep their employees safe. Take the time to check out what security measures are in place for staff -- parking, security presence, etc. -- before you dismiss the job because of the neighborhood.

You will definitely get a different patient population than you would in the suburbs, but on the other hand, the learning opportunities are enormous!

As far as the commute: do you have dependable child care? Is there someone who will be available for your children in the event that you are late coming home from work, have to drive to work in a blizzard or need to stay at work during a hurricane? The suburban hospitals will have the same questions/requirements, but the hourlong commute may change some of those parameters for you. Before you take a job, make sure you're prepared to be there when you're supposed to be barring unforeseen (and I don't mean the snowstorm or hurricane that's been on the weather forecast for three days) emergencies.

The dependable car is a consideration as well. If you don't have one now, can you buy one within the first couple of months of your employment?

Good luck -- I hope I've given you food for thought.